Therapie mit Biologicals. Gibt es eine Differenzialindikation?

Zusammenfassung

Therapeutisches Ziel bei entzündlich-rheumatischen Erkrankungen ist die effektive Hemmung proinflammatorischer Zytokine. Vier Antizytokin-Therapien mit eindrucksvoller Effektivität sind gegenwärtig in Deutschland zugelassen. Anhand einer Literaturrecherche (Pubmed) wurde der Frage nachgegangen, ob sich aufgrund einer unterschiedlichen Wirksamkeit oder eines unterschiedlichen Nebenwirkungsprofils eine Differenzialindikation der einzelnen Antizytokin-Therapien ableiten lässt. Nach der bisherigen Datenlage besteht nur beim Morbus Crohn bzw. bei den enteropathischen (Spondylo-)Arthropathien eindeutig eine Differenzialindikation, in diesem Fall für Infliximab als Mittel der ersten Wahl. Trotz eines differenten Wirkungsspektrums der einzelnen Antizytokin-Therapien ergibt sich bei allen anderen entzündlich-rheumatischen Erkrankungen keine eindeutige Differenzialindikation. Bezüglich des unterschiedlichen Nebenwirkungsprofils der einzelnen Antizytokin-Therapien ist bei fraglichem Tuberkulosekontakt eher das TNF-α-Rezeptorfusionsprotein als die monoklonalen Antikörper zu bevorzugen. Mögliche Ursachen dieser Unterschiede in der Wirksamkeit und im Nebenwirkungsprofil werden abschließend diskutiert.

Abstract

Therapy of chronic inflammatory rheumatic diseases is targeting on effective inhibition of proinflammatory cytokines. Till now, four impressingly effective anti-cytokine substances are established in Germany. Substantial differences in efficacy and occurence of adverse events of these anti-cytokine agents were researched using a literature data bank (PubMed) to work out different indications. The previous data bank only pointed out a clear preference of infliximab in the treatment of M.CROHN and enteropathic spondarthropathies. Although showing different modes of action different indications for the treatment of the other chronic inflammatory rheumatic diseases could not be detected. Concerning tolerability specially in case of Tbc-suspicion, the TNF-α-Inhibitor etanercept should be prefered over the monoklonal antibodies infliximab and adalimumab. Possible explanations of these differences in efficacy and tolerability were discussed.

Schlüsselwörter

Antizytokin-Therapien - Adalimumab - Anakinra - Etanercept - Infliximab - Wirksamkeit - Nebenwirkungen

Key words

Anti-cytokine therapy - adalimumab - anakinra - etanercept - infliximab - efficacy - adverse events

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